犀泽汤联合拉米夫定治疗肝郁脾虚兼湿热型慢性乙型肝炎的效果分析
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摘要
目的探讨犀泽汤联合拉米夫定治疗肝郁脾虚兼湿热型慢性乙型肝炎HBe Ag阳性患者的疗效。方法我院收治的130例中医辨证类型为肝郁脾虚兼湿热型的慢性乙型肝炎HBe Ag阳性患者,按随机数字表法分为两组,对照组(n=65)采用拉米夫定治疗,观察组(n=65)在此基础上联合给予犀泽汤,疗程均为48周。观察治疗前和治疗1年后两组肝功能酶学指标,HBe Ag阴转率,乙肝病毒耐药率,临床总有效率,并结合健康调查简表(SF-36量表)、慢性肝病量表(CLDQ)评分评价治疗效果。结果对照组总有效率为46.15%,HBe Ag阴转率13.85%,耐药率27.70%,观察组总有效率为87.69%,HBe Ag阴转率32.31%,耐药率9.23%,差异有统计学意义(P<0.05)。与治疗前比较,治疗后两组谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆汁酸(TBA)值均降低,且观察组ALT和AST水平均低于对照组(P<0.05);两组中医证候评分均降低,且观察组优于对照组(P<0.05);两组SF-36量表和CLDQ量表评分均增加,且观察组优于对照组(P<0.05)。结论针对肝郁脾虚兼湿热型慢性乙型肝炎HBe Ag阳性患者,犀泽汤联合拉米夫定治疗可获得良好疗效,值得应用推广。
Objective To investigate the therapeutic effect of Xieze decoction combined with lamivudine in the treatment of patients with chronic hepatitis B diagnosed as TCM syndrome type of liver-depression/spleen-deficiency combined with hot and humid.Methods One hundred and thirty patients with chronic hepatitis B who were diagnosed as TCM syndrome type of liver-depression and spleen-deficiency combined with hot and humid were randomly divided into control or observation group,65 in each group.The control group was treated with simple lamivudine while the observation group was treated with a combination of Xieze decoction and lamivudine.The course of treatment was 48 weeks.The liver function enzymatic indexes,HBe Ag negative transfer rate,drug resistance rate and total clinical efficacy were observed before treatment and after 1 year of treatment.In addition,a summary health survey( SF-36 scale) and a chronic liver disease scale( CLDQ) score were used to further evaluate the therapeutic effect. Results In the control group,the total effective rate was 46. 15%,the HBe Ag negative transfer rate was 13. 85%,and the drug resistance rate was 27. 70%.In the observation group,the total effective rate was 87. 69%,the HBe Ag negative transfer rate was 32. 31% and the drug resistance rate was 9. 23%.The differences between the two groups were statistically significant( P < 0. 05).Compared to before treatment,the alanine aminotransferase( ALT),glutamic pyruvate transaminase( AST) and total bile acid( TBA) values were decreased after treatment in the both groups,and the levels of ALT and AST in the observation group were lower than those in the control group( P < 0. 05). The TCM syndrome scores were reduced compared to before treatment in the both groups,and the observation group was better than the control group( P <0. 05).Compared to before treatment,the SF-36 scale score and the CLDQ scale score were increased after treatment in the both groups,and the observation group was better than the control group( P < 0. 05). Conclusion For chronic hepatitis B patients with TCM syndrome of liver-depression/spleen-deficiency with damp-heat,the combination of Xieze decoction and lamivudine can obtain good curative effect.Therefore,it is worthy of application and promotion.
Objective To investigate the therapeutic effect of Xieze decoction combined with lamivudine in the treatment of patients with chronic hepatitis B diagnosed as TCM syndrome type of liver-depression/spleen-deficiency combined with hot and humid.Methods One hundred and thirty patients with chronic hepatitis B who were diagnosed as TCM syndrome type of liver-depression and spleen-deficiency combined with hot and humid were randomly divided into control or observation group,65 in each group.The control group was treated with simple lamivudine while the observation group was treated with a combination of Xieze decoction and lamivudine.The course of treatment was 48 weeks.The liver function enzymatic indexes,HBe Ag negative transfer rate,drug resistance rate and total clinical efficacy were observed before treatment and after 1 year of treatment.In addition,a summary health survey( SF-36 scale) and a chronic liver disease scale( CLDQ) score were used to further evaluate the therapeutic effect. Results In the control group,the total effective rate was 46. 15%,the HBe Ag negative transfer rate was 13. 85%,and the drug resistance rate was 27. 70%.In the observation group,the total effective rate was 87. 69%,the HBe Ag negative transfer rate was 32. 31% and the drug resistance rate was 9. 23%.The differences between the two groups were statistically significant( P < 0. 05).Compared to before treatment,the alanine aminotransferase( ALT),glutamic pyruvate transaminase( AST) and total bile acid( TBA) values were decreased after treatment in the both groups,and the levels of ALT and AST in the observation group were lower than those in the control group( P < 0. 05). The TCM syndrome scores were reduced compared to before treatment in the both groups,and the observation group was better than the control group( P <0. 05).Compared to before treatment,the SF-36 scale score and the CLDQ scale score were increased after treatment in the both groups,and the observation group was better than the control group( P < 0. 05). Conclusion For chronic hepatitis B patients with TCM syndrome of liver-depression/spleen-deficiency with damp-heat,the combination of Xieze decoction and lamivudine can obtain good curative effect.Therefore,it is worthy of application and promotion.
引文
[1]Polaris Observatory Collaborators.Global prevalence,treatment,and prevention of hepatitis B virus infection in 2016:a modelling study[J].Lancet Gastroenterol Hepatol,2018,3(6):383-403.
[2]萧焕明,池晓玲,杨志敏,等.犀泽汤治疗慢性乙型肝炎40例疗效观察[J].临床和实验医学杂志,2009,8(11):50-52
[3]李春英,王静,王浩,等.逍遥散联合拉米夫定治疗慢性乙型肝炎39例预后分析[J].中国药业,2018,27(4):44-47
[4]de Niet A,Jansen L,Stelma F,et al.Peg-interferon plus nucleotide analogue treatment versus no treatment in patients with chronic hepatitis B with a low viral load:a randomised controlled,open-label trial[J].Lancet Gastroenterol Hepatol,2017,2(8):576-584.
[5]柯辉,陈都红,胡艳萍.拉米夫定联合百令胶囊治疗干扰素无应答儿童慢性乙型肝炎的临床研究[J].中西医结合肝病杂志,2017,27(4):209-211.
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[7]Janfeshan S,Yaghobi R,Eidi A,et al.Expression Profile of Interferon Regulatory Factor 1 in Chronic Hepatitis B Virus-Infected Liver Transplant Patients[J].Exp Clin Transplant,2017 15(6):669-675.
[8]Xiao G,Yang J,Yan L.Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis-4 index for detecting liver fibrosis in adult patients with adult patients with chronic hepatitis B virus infection:a systemic review and meta-analysis[J].Hepatology,2015,61(1):292-302.
[9]Lee IC,Chau GY,Yeh YC,et al.Risk of recurrence in chronic hepatitis B patients developing hepatocellular carcinoma with antiviral secondary prevention failure[J].PLo S One,2017,12(11):e0188552.
[10]Hu YC,Liu H,Liu XY,et al.Value of gamma-glutamyltranspeptidase-to-platelet ratio in diagnosis of hepatic fibrosis in patients with chronic hepatitis B[J].World J Gastroenterol,2017,23(41):7425-7432.
[11]Chien CH,Chen LW,Lin CL,et al.Unawareness of Hepatitis B Virus Infection confers on Higher Rate of Metabolic Syndrome:A Community-based Study[J].Sci Rep,2017,7(1):9869.
[12]Ren T,Wang H,Wu R,et al.Gamma-Glutamyl Transpeptidase-toPlatelet Ratio Predicts Significant Liver Fibrosis of Chronic Hepatitis B Patients in China[J].Sci Rep,2017 7(1):8543.
[13]Wang HW,Peng CY,Lai HC,et al.New noninvasive index for predicting liver fibrosis in Asian patients with chronic viral hepatitis[J].Sci Rep,2017,7(1):3259.
[14]Lee GM,Kim YR,Ryu JH,et al.Quantitative Measurement of Hepatic Fibrosis with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Chronic Hepatitis B Infection:A Comparative Study on Aspartate Aminotransferase to Platelet Ratio Index and Fibrosis-4 Index[J].Korean J Radiol,2017,18(3):444-451.
[15]Parikh P,Ryan JD,Tsochatzis EA.Fibrosis assessment in patients with chronic hepatitis B virus(HBV)infection[J].Ann Transl Med,2017,5(3):40.
[2]萧焕明,池晓玲,杨志敏,等.犀泽汤治疗慢性乙型肝炎40例疗效观察[J].临床和实验医学杂志,2009,8(11):50-52
[3]李春英,王静,王浩,等.逍遥散联合拉米夫定治疗慢性乙型肝炎39例预后分析[J].中国药业,2018,27(4):44-47
[4]de Niet A,Jansen L,Stelma F,et al.Peg-interferon plus nucleotide analogue treatment versus no treatment in patients with chronic hepatitis B with a low viral load:a randomised controlled,open-label trial[J].Lancet Gastroenterol Hepatol,2017,2(8):576-584.
[5]柯辉,陈都红,胡艳萍.拉米夫定联合百令胶囊治疗干扰素无应答儿童慢性乙型肝炎的临床研究[J].中西医结合肝病杂志,2017,27(4):209-211.
[6]Zare A,Karimi MH,Rashki A,et al.Association of the Interleukin-27Gene Expression and Hepatitis B Virus Infection in Liver Transplanted Patients[J].Exp Clin Transplant,2017,15(5):554-560.
[7]Janfeshan S,Yaghobi R,Eidi A,et al.Expression Profile of Interferon Regulatory Factor 1 in Chronic Hepatitis B Virus-Infected Liver Transplant Patients[J].Exp Clin Transplant,2017 15(6):669-675.
[8]Xiao G,Yang J,Yan L.Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis-4 index for detecting liver fibrosis in adult patients with adult patients with chronic hepatitis B virus infection:a systemic review and meta-analysis[J].Hepatology,2015,61(1):292-302.
[9]Lee IC,Chau GY,Yeh YC,et al.Risk of recurrence in chronic hepatitis B patients developing hepatocellular carcinoma with antiviral secondary prevention failure[J].PLo S One,2017,12(11):e0188552.
[10]Hu YC,Liu H,Liu XY,et al.Value of gamma-glutamyltranspeptidase-to-platelet ratio in diagnosis of hepatic fibrosis in patients with chronic hepatitis B[J].World J Gastroenterol,2017,23(41):7425-7432.
[11]Chien CH,Chen LW,Lin CL,et al.Unawareness of Hepatitis B Virus Infection confers on Higher Rate of Metabolic Syndrome:A Community-based Study[J].Sci Rep,2017,7(1):9869.
[12]Ren T,Wang H,Wu R,et al.Gamma-Glutamyl Transpeptidase-toPlatelet Ratio Predicts Significant Liver Fibrosis of Chronic Hepatitis B Patients in China[J].Sci Rep,2017 7(1):8543.
[13]Wang HW,Peng CY,Lai HC,et al.New noninvasive index for predicting liver fibrosis in Asian patients with chronic viral hepatitis[J].Sci Rep,2017,7(1):3259.
[14]Lee GM,Kim YR,Ryu JH,et al.Quantitative Measurement of Hepatic Fibrosis with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Chronic Hepatitis B Infection:A Comparative Study on Aspartate Aminotransferase to Platelet Ratio Index and Fibrosis-4 Index[J].Korean J Radiol,2017,18(3):444-451.
[15]Parikh P,Ryan JD,Tsochatzis EA.Fibrosis assessment in patients with chronic hepatitis B virus(HBV)infection[J].Ann Transl Med,2017,5(3):40.